Repeated Partial Sleep Deprivation to Augment SSRI Response in Depression

Depression is common and associated with social and economic costs. Although antidepressant medications are an effective treatment for depression, it can take as long as 6-8 weeks before symptoms improve, and 20-35% of individuals who use antidepressants still experience depression symptoms.

New treatments that accelerate response to antidepressants are important to reduce the burden of depression. The objectives of the proposed study are (1) to evaluate the effects of partial sleep deprivation compared to no sleep deprivation for improving response to 8 weeks of fluoxetine 20-40 mg treatment and (2) to examine the underlying sleep mechanisms of treatment response.

Participants who are eligible for the study will be randomly assigned to one of three sleep schedules for a 2-week period while taking fluoxetine: no sleep deprivation (8 hours time in bed), late bedtime (6 hours time in bed, with 2 hour bedtime delay) or early risetime (6 hours time in bed, with 2 hour advancement of rise time). Participants will spend a total of 7 nights in our sleep laboratory and will be followed on fluoxetine for an 8-week period.

Inclusion criteria

• Between 18 and 65 years old
• Current major depressive episode
• Habitual TIB of 7 to < 10 hours
• No antidepressant medications for ≥ 2 weeks (4 weeks for MAOIs or longer acting antidepressants)
• Score of at least 18 on the Hamilton Rating Scale of Depression

Exclusion criteria

• Alcohol or substance abuse/dependence in past 6 months
• Current posttraumatic stress disorder or bulimia nervosa (past 6 months)
• Lifetime history of bipolar I or II disorder, schizophrenia/other psychotic disorder, and anorexia nervosa
• Trials of fluoxetine in the past 6 months
• Medical disorders or pain syndromes that may affect sleep or are associated with significant depression (e.g. thyroid or Cushing's disease); history of head trauma with loss of consciousness of > 5 minutes; history of seizures
• Sleep disorders other than insomnia, such as sleep apnea and periodic limb movement disorder
• Current use of prescription, over-the-counter, or naturopathic remedies for sleep (e.g., barbiturates, benzodiazepine agonists, nonbenzodiazepine hypnotics, analgesics) or depression (e.g., Sam-E, St. John's Wort)
• Currently working evening or midnight shift (subjects who have recently traveled across multiple time zones will be included at the discretion of the PI).
• Currently at risk for drowsy driving or employment that requires routine operation of transportation vehicles (e.g., truck/taxi driver, airline pilot) or hazardous equipment.
• Known allergy, hypersensitivity or contraindication to study medication
• Females: pregnant or nursing